Abstract
Purpose :
There is very little published literature on the long term benefits of anti-VEGF (Vascular Endothelial Growth Factor) treatment for neovascular age-related macular degeneration (nvAMD). We assessed 10-year mortality and clinical outcomes in nvAMD patients treated with intravitreal anti-VEGF injections on a PRN (pro-re-nata) regime.
Methods :
This is a retrospective cohort study of the first 229 patients presenting to a tertiary ophthalmology unit who were commenced on intravitreal anti-VEGF treatment for treatment of nvAMD. Data was collected from retrospective review of case notes and online medical records. The main outcome measures were mortality, cause of death and best corrected visual acuity (BCVA). Wilcoxon rank test was used to examine differences in BCVA.
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Results :
232 eyes from 229 patients with nvAMD were included. Average annual mortality rate over the 10 year period was 4.7%. This compared with a national over 75 years old population average mortality rate of 7.5%. The average age at presentation was 77 yrs old and average age of death in our cohort was 88.2 years. The commonest causes of death were malignancy (36.2%) and circulatory disease (32.5%). Following PRN anti-VEGF therapy (mean 84 months), there was a mean loss of vision of 33 letters (p<0.05) in BCVA. Average BCVA at presentation was 59 ETDRS letters, and average BCVA at last clinic follow up was 26 ETDRS letters. Patients received a mean of 2.3 injections/year. 21% patients were discharged from clinic, 31% were still undergoing treatment, and 23.1% were registered blind.
Conclusions :
This study highlights the long term poor prognosis of nvAMD despite intravitreal anti-VEGF treatment. Significant loss of vision and high rates of blind registration were recorded, leading to increasing demand on the public health service. The mortality rate for our cohort reassuringly appears to be lower than the average national mortality rate. Our BCVA outcomes are likely inferior to other long term studies as a result of the reactive PRN treatment regimen in place in our unit and relatively low number of anti-VEGF injections performed per patient per year. Improved clinical outcomes would be expected with a proactive treat and extend regimen.
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This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.